Roxanne Nelson

September 28, 2012

September 28, 2012 — Cancer poses a considerable economic burden in Europe, through both direct and indirect costs, and takes a considerable toll on caregivers, according to data from 2 new studies.

In the European Union, healthcare costs for cancer are estimated to be €124 billion each year, with lung cancer representing the highest overall burden. The lowest per capita cost for cancer is in Lithuania (€32/year) and the highest is in Germany (€165/year).

Caregivers of cancer patients add to the economic burden of the disease; they report significantly poorer overall, physical, and emotional health, and use more healthcare resources.

Both studies will be presented at the 2012 European Society for Medical Oncology (ESMO) Congress, being held in Vienna, Austria.

"Here we have 2 studies of enormous importance," said Peter Boyle, PhD, DSc(Med), DSc, in a press release. Dr. Boyle is president of the International Prevention Research Institute in Lyon, France, and member of the ESMO faculty group on cancer prevention.

"These studies provide a background on which logical funding decisions can be made, noted Dr. Boyle, who was not involved in either study.

Costs Vary by Cancer Type and Country

In the study on healthcare costs, Ramon Luengo-Fernandez, MD, from the University of Oxford in the United Kingdom, and colleagues estimate the 2009 economic cost of cancer for all 27 countries in the European Union, as well as the proportion of total cancer costs related to the 4 major types of the disease: lung, colorectal, female breast, and prostate.

"Cancer poses a considerable economic burden, not only to healthcare systems but to other areas of the economy, including productivity losses through early mortality and time off work, and relatives who have to forego work/leisure to care for cancer patients," Dr. Luengo-Fernandez said in a statement.

"Healthcare systems will have a good idea, I expect, of the healthcare costs of providing cancer care to their patients," he explained. "However, the productivity losses and informal care costs associated with cancer will be less well understood and their magnitude less appreciated," he added.

The researchers estimated the costs of variables such as primary care, hospital care, unpaid care by family and friends, and lost earnings due to morbidity and premature death using a "top-down" framework. This involved identifying the volume of resources that were associated with each category annually and their respective unit costs.

The data were drawn from a number of international and national sources, structured literature searches, and an analysis of patient household surveys in the European Union.

In 2009, cancer cost an estimated €234 per capita, with healthcare accounting for 36% of costs (€84/per capita) and representing more than 58 million hospital bed days. In addition, lost earnings due to premature death accounted for 36% of costs, morbidity accounted for 8%, and unpaid care accounted for 20%.

The researchers found that there was a great deal of variation in the different countries; the highest economic burden was in Germany, which accounted for 26% of the total costs in the European Union.

"The countries with the highest per capita costs in terms of cancer healthcare tend to be Northern and Central European countries. Those with the lowest per capita costs tend to be member states that joined the European Union in 2004 and have lower national income levels," said Dr. Luengo-Fernandez in a statement.

Of the 4 major cancer types, lung cancer accounted for 16% of the overall cancer costs, followed by colorectal cancer (11%), breast cancer (10%), and prostate cancer (5%).

High Burden on Caregivers

In the study of caregivers, Isabelle Gilloteau, MPH, from Bristol-Myers Squibb in Paris, France, and colleagues evaluated the extent of the cancer burden on caregivers.

They obtained data from the 2010 and 2011 self-administered online EU National Health and Wellness Surveys on 105,581 adults in France, Germany, Italy, Spain, and the United Kingdom.

After adjustment for covariates, the researchers found that the 847 caregivers reported significantly worse health status than the 52 noncaregivers. They also reported higher mean levels of absenteeism (8.39% vs 4.76%; P < .001), overall work impairment (26.43% vs 18.09%; P < .001), and activity impairment (28.85% vs 21.91%; P < .001).

In addition, caregivers made more visits to healthcare providers (6.53 vs 4.89; P < .001) and emergency departments (0.26 vs 0.16; P = .002) and had more hospitalizations (0.19 vs 0.10; P = .003) during the previous 6 months. Caregivers were more likely than noncaregivers to be diagnosed with depression (odds ratio [OR], 1.455; P < .001), anxiety (OR, 1.972; P < .001), insomnia (OR, 1.945; P < .001), migraine (OR, 1.697; P < .001), and gastrointestinal problems (OR, 1.644; P < .001).

"This study underscores the importance of recognizing caregiver burden, not just because of the direct implications for the wellbeing and quality of care of the patient with cancer, but also because of the extra burden it brings to society overall," Gilloteau said in a release. "Because caregiving is a vital part of cancer patient management and because providing this care incurs substantial burden for the caregiver, it is crucial to consider what can be done to minimize this burden, especially in the current context of containment, an aging population, and the increasing incidence of cancer."

Dr. Luengo-Fernandez and coauthors have disclosed no relevant financial relationships. Ms. Gilloteau and coauthors all report relationships with Bristol-Myers Squibb, which funded this study.

2012 European Society for Medical Oncology (ESMO) Congress: Abstracts 1415 and 1418. To be presented October 1, 2012.